7 takeaways from @AbujaGSC dialogue on health financing in Nigeria

The issue of health financing, funding and the rising cost of health care in Nigeria were on the front burner last Friday at the Dialogue Series of the Global Shapers Community in Abuja.

Health experts, members of the Shapers Community and other interested members of the public converged at the Civic Innovation Lab to listen to a panel comprising Sen. Lanre Tejuosho, the Chair of Senate Committee on Health; Dr. Chikwe Ihekweazu, Chief Executive Officer, Nigerian Center for Disease Control (NCDC); Dr. Nkata Chuku, Founding Partner, Health Systems Consult Limited; and Dr. Funke, who represented the Country Director, ONE Campaign, Mrs. Sarah Makka-Ugbabe.

Below are 7 takeaways from the discussion:

1. What sort of model does Nigeria want for financing its health sector?:

Ihekweazu listed three main models of health financing – Public financing (through taxes); Insurance model; and Social insurance. “In all of this space, there is no clear political direction, no clear narrative on which model we as a society want to use. The key architects need to help us define what model we want to use as a society,” he said. In the short video below, he defines the three models:

In a one-on-one interview after the event with The Scoop Editor, Stanley Azuakola, Ihekweazu said he would prefer “the social insurance model for Nigeria.” He said even though the tax funded model is good, Nigerians don’t value things in which they don’t put something on the table.

For Sen. Tejuosho: “Health insurance needs to be made mandatory for all Nigerians. If every Nigerian contributes N100 monthly and let’s work on 100 million people, we will have about N10 billion every month, which is about N120 billion a year, which is more than what they are providing for the health sector presently.”

For Dr. Chuku: Social insurance as being proposed by Ihekweazu and Tejuosho “is not the only way to fund health. There are opportunities we can leverage on, like a tax on telecoms dedicated to financing the health sector.”

2. On the dire funding challenge in the sector, Sen. Tejuosho had this to say:

“In October of 2017, the government can only release 15% of even what it budgeted for this year. This is October, we have two more months to go. We are saying the budget is not enough but even what has been appropriated for this year only 15% is available. Unless we go borrowing again, we cannot fund it.”

3. The panel agreed that Nigerians have to be ready to pay for health. Dr. Funke summed up the predominant view this way: “Healthcare is not cheap. We need to change that mindset that everything is free. We need to look at investment in health as an investment in the future and not just as a social responsibility.”

4. But the lack of funds is not the only issue. How about these?:

Dr. Chuku was applauded by the audience when he made this observation: “Beyond the lack of funds, we need to talk about the crazy inefficiency as well as the implementation of the budget in the health sector. Right now the bulk of the budget goes into per diem, salaries, attending international workshops, conferences and the likes.”

Dr. Ihekweazu made a different point to underline the inefficiency in the system. He said Nigeria has been unable to use the sheer scale of its population to negotiate the downward review of the prices of drugs. “Every hospital in Nigeria purchases panadol on its own. There’s no efficiency of scale. We have been unable to use our size to negotiate. The reason the price of Anti-retroviral (ARV) drugs for the treatment of HIV is cheaper is because the biggest purchaser in the world is the government of South Africa which has used its scale to beat down the prices. As the largest market in Africa, if Nigeria uses our population power to negotiate, we can force down the price of almost any drug.”

5. Know your rights:

Dr. Chuku asked Nigerians to pick a copy of the National Health Care Act and read. “My best part of the Act is the part that says the minister should publish an annual health report. Does it happen? My second best part is the part that explain the rights of citizens and responsibilities. We as citizens need to begin to live up to some responsibilities,” he said.

For reference purposes, here is a copy of the National Health Act. Section which deals with the annual health report by minister is Section 2(2) which says the ministry of health needs “to prepare strategic, medium term health and human resources plan annually for the exercise of its powers and the performance of its duties.” According to the law, the health plan shall for the basis of the annual budget proposal. Rights and obligations of health users and personnel is in Part 3 of the Act.

Sen. Tejuosho said his committee is proposing a separate salary structure for doctors to make their pay comparable to other nations. But then – he said – we would have pharmacists and other professionals say they want same.

The senator said he tells development partners to set aside 15% of the budget they spend in the country to “pay some of our doctors abroad to come back here and work.”

In an interview afterwards with Editor of The Scoop, Stanley Azuakola, Sen. Tejuosho enunciated on his idea for donors to cut funding for vaccines and other equipment by half and use same for paying doctors to return. Watch video below from 2:15 minutes:

For Dr. Chuku: Many Nigerian doctors abroad will come back today if they had the enabling environment. He recalled an idea shared with a previous administration for the set up of a Special Intervention Fund to guarantee loans for people trying to invest in health. That did not happen, he said, but shortly afterwards, government announced an intervention fund for Nollywood. “Government has to find a way to de-risk health investments. We asked government to guarantee loans because when banks guarantee, they add a huge cost on it. If government unlocks the potential of the private sector, those doctors will come back and the government won’t have to pay them.”

7. Now he is pushing it:

Sen. Tejuosho made a hardly believable claim while speaking on the issue of brain drain: “If Nigerian doctors withdraw their services in the UK today, the health care system of the UK will collapse,” he said. “It is Nigerians that sustain the health system of the UK.”